Treatment of Anxiety Flashcards
(35 cards)
Long term treatment goal for GAD, PD, SAD and PTSD (2)
- remission of core anxiety symptoms
- recovery of function
Long term treatment goal for OCD (2)
- complete resolution of symptoms is often difficult to achieve
- relapse rate very high with poor medication adherence
Objective assessment of outcomes (3)
- Psychiatric rating scales
eg Hamilton Anxiety Scale - identify target symptoms for each type of anxiety disorders (classify which type of anxiety disorders the patient have)
- keep detailed diary to record fear levels, physical symptoms, cognition and anxious behaviours
Non-pharmacological management
- recommended in combination to medication treatment
- cognitive behavioural therapy
eg OCD = CBT + SSRI/Clomipramine
Duration of medication treatment
GAD, SAD, PD & PTSD
- 1 year
OCD
- 1-2 years
What type of antidepressants good for anxiety disorders & why
All serotonergic agents
eg SSRI, SNRI
- promote 5-HT transmissions have efficacy for anxiety disorders
- 5-HT inhibit amygdala output
Antidepressants efficacy & dosing features for anxiety (3)
- effective for worrying/apprehension type of symptoms
- initiate at low dose then gradually titrate up to maximum dose range
- maintenance dose usually will be at high end of therapeutic range
Time to respond for antidepressants
- 6-12 weeks
- maximum response may take 3 months
Discontinuation of antidepressants in anxiety
- gradually taper dose to avoid discontinuation syndrome (FINISH)
eg 10-25% reduction in dose every 1-2 weeks
What type of benzodiazepines good for anxiety disorders (4)
- Diazepam
- Lorazepam
- Clonazepam
- Alprazolam
Benzodiazepines efficacy in anxiety (4)
- not recommended for monotherapy
- short course PRN (3-4 months)
- quick onset of effects (~30min)
- effective for physical/somatic symptoms
Discontinuation of benzodiazepines in anxiety
- gradual taper to avoid rebound anxiety
Abrupt discontinuation with antidepressants vs benzodiazepines
Abrupt discontinuation with antidepressants
- Serotonin Withdrawal Symptoms (FINISH)
Abrupt discontinuation with benzodiazepines
- rebound anxiety
Significant DDI with benzodiazepines
- CNS depressants
eg benzodiazepines & opioids = increased risk of mortality
Early ADR of anxiety treatment
- possible increased anxiety (transient jitteriness) with antidepressants during 1-2 weeks
- N/V, insomnia/sedation, headache (usually subsides 2-3 weeks of continued treatment)
Long term ADR of anxiety treatment
- SD
- weight gain
may lead to discontinuation of treatment
Types of anxiety disorders (5)
- General Anxiety Disorder (GAD)
- Social Anxiety Disorder (SAD)
- Panic Disorder (PD)
- Post Traumatic Stress Disorder (PTSD)
- Obsessive Compulsive Disorder (OCD)
Anxiety disorders (3)
- severe, excessive, persistent anxiety
- irrational fears that impairs functioning with everyday living (severe)
- anxiety is out of proportion to the actual danger or threat (excessive)
- persists long even after original trigger disappeared (persistant)
Prevalence of OCD in Singapore
3.6%
Generalised Anxiety Disorder (GAD)
- excessive anxiety & worries
- at least 6 months
Panic Disorder (PD)
- anticipatory anxiety of recurrent panic attacks
Social Anxiety Disorder (SAD)
- fear of being scrutinised or humiliated by others in public
Obsessive Compulsive Disorder (OCD)
- obsessional thoughts/impulses that causes anxiety
- patient is aware that thoughts are product of their own mind
- followed by compulsive behaviours to relieve that anxiety that is excessive & repetitive
Post-Traumatic Stress Disorder (PTSD) (3)
- re-experiencing of trauma
- persistent avoidance
- increased arousal
